Table Of ContentNaval Medical Center Portsmouth (NMCP) COVID-19 Literature Report
#85: Friday, 21 January 2022
Prepared By: Tracy C. Shields, MSIS, AHIP (Ms.; she/her) <[email protected]>
Naval Medical Center Portsmouth; Library Services, Reference Medical Librarian
Purpose: These reports, published every other week on Fridays, are curated collections of
current research, evidence reviews, special reports, grey literature, and news regarding the
COVID-19 pandemic that may be of interest to medical providers, leadership, and decision
makers. Please reach out with questions, suggestions for future topics, or any other feedback.
If this report made a difference or impacted patient care, please let me know!
All reports are available online at https://nmcp.libguides.com/covidreport. Access is private;
you will need to use the direct link or bookmark the URL.
Disclaimer: I am not a medical professional. This document is current as of the date noted
above. While I make every effort to find and summarize available data, I cannot cover
everything in the literature on COVID-19. Due to the rapid evolution of the literature, I will not
update past reports when new information arises; for retracted papers specific to COVID-19,
see the list of retracted papers from Retraction Watch.
TABLE OF CONTENTS
The Big Picture . . . . . 2 Pediatric Population . . . . . 20
SARS-CoV-2 Virus and Variants . . . . . 4 Healthcare Workers . . . . . 21
COVID-19 Vaccines . . . . . 5 Disparities and Health Equity . . . . . 23
Breakthrough Infections and Reinfections . Transmission, Exposure, and Testing . . . . .
. . . . 7 24
Treatments and Management . . . . . 10 Misinformation and Health Messaging . . . .
. 25
Pre-Existing Conditions, Comorbidities, and
Complications . . . . . 13 Other Infectious Diseases and Public
Health Threats . . . . . 26
Long COVID / Post-COVID Syndrome . . . . .
14 Statistics . . . . . 27
Maternal Health, Pregnancy, and Perinatal References . . . . . 28
Period . . . . . 16
NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
The Big Picture
News in Brief
"What happens after omicron? Four key questions about where the pandemic goes next"
(BuzzFeed).
"How the COVID-19 pandemic might age us" (Nature).
"Report outlines 8 steps for current, future pandemics" (CIDRAP).
Shortages
"Doctors and patients are facing tough choices because of the national blood crisis" (NPR).
"A cascade of Omicron-driven shortages puts U.S. hospitals in a bind" (STAT).
Webinars
WHEN: 1700–1830 ET 26 January 2022 (on Zoom)
WHAT: The Third Year of COVID-19: Is This the New Normal?
DETAILS: "The latest COVID-19 Conversations webinar will provide insight into what we
have learned from the omicron variant, and how that knowledge, as well as an
evolving understanding of vaccine efficacy, emerging therapeutics, and public
health guidance can help us move toward the new normal.
Participants can earn 1.5 CPH, CME, CNE, or CHES continuing education credits."
REGISTER: https://covid19conversations.org/Webinar-Registration
SEE ALSO: previous COVID-19 Conversations in this series
Journal Articles
Sci Rep: Understanding the uneven spread of COVID-19 in the context of the global
interconnected economy (13 January 2022)
"The worldwide spread of the COVID-19 pandemic is a complex and multivariate process
differentiated across countries, and geographical distance is acceptable as a critical
determinant of the uneven spreading. Although social connectivity is a defining condition
for virus transmission, the network paradigm in the study of the COVID-19 spatio-temporal
spread has not been used accordingly. Toward contributing to this demand, this paper uses
network analysis to develop a multidimensional methodological framework for
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
understanding the uneven (cross-country) spread of COVID-19 in the context of the globally
interconnected economy. The globally interconnected system of tourism mobility is
modeled as a complex network and studied within the context of a three-dimensional (3D)
conceptual model composed of network connectivity, economic openness, and spatial
impedance variables. The analysis reveals two main stages in the temporal spread of COVID-
19, defined by the cutting-point of the 44th day from Wuhan. The first describes the
outbreak in Asia and North America, the second stage in Europe, South America, and Africa,
while the outbreak in Oceania intermediates. The analysis also illustrates that the average
node degree exponentially decays as a function of COVID-19 emergence time. This finding
implies that the highly connected nodes, in the Global Tourism Network (GTN), are
disproportionally earlier infected by the pandemic than the other nodes. Moreover,
countries with the same network centrality as China are early infected on average by
COVID-19. The paper also finds that network interconnectedness, economic openness, and
transport integration are critical determinants in the early global spread of the pandemic,
and it reveals that the spatio-temporal patterns of the worldwide spreading of COVID-19
are more a matter of network interconnectivity than of spatial proximity."
Mil Med: Combating the Current Pandemic and Preparing for the Next: Lessons Learned From
the COVID-19 Pandemic From the Perspective of Deployed Special Operations Forces (11
January 2022)
"The coronavirus 2019 (COVID-19) pandemic continues to be a threat to global health,
including the health of deployed armed forces. Servicemembers had to adjust to the "new
normal" while maintaining the interests of the nation's security as well as that of our host
nation partners. This commentary examines how Special Operations Forces operating
within four different regions worldwide leveraged the challenges presented by the onset of
this pandemic in maintaining stability, sustaining a ready force, and operating forward
deployed. Deployed forces face constant difficulties with logistical support, varied medical
resources access and a medical system predominantly focused on trauma care. At the onset
of the COVID-19 pandemic there was little guidance specific to these circumstances which
required an improvised adaptation of the recommendations set by national and
Department of Defense medical authorities. Plans were constantly revised to match the
ever changing medical and operational environment. Strategies such as the "Bubble
Philosophy" and tiered force protection measures helped our units to maintain a rigorous
training cycle. New methods of communication and training with our host nation partners
such as the use of Unmanned Aerial Systems (UAS) platforms to survey host nation training
became standard. Through these measures all of our forces were able to maintain
operational capacity, protect the force, and maintain rapport with the host nations. We
hope these experiences will provide a rough framework for future forces faced with a
similar struggle. We also want to stress that challenges vary depending on the area of
operations and the pathogen responsible for the pandemic."
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
SARS-CoV-2 Virus and Variants
News in Brief
"How fast the omicron variant is spreading around the world — The variant detected in
November has overtaken delta as the dominant version of the coronavirus" (WP).
"After Omicron, we could use a break. We may just get it" (STAT).
"Omicron thwarts some of the world's most-used COVID vaccines" (Nature).
"The worst of the omicron wave could still be coming — A long descent from a peak in cases
could exact a larger toll than even Omicron’s blistering ascent" (Atlantic).
Journal Articles
MMWR: COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults
with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence — 25
U.S. Jurisdictions, April 4–December 25, 2021 (early release 21 January 2022)
"What is already known about this topic? Although COVID-19 vaccine effectiveness
decreased with emergence of the Delta variant and waning of vaccine-induced immunity,
protection against hospitalization and death has remained high.
What is added by this report? In 25 U.S. jurisdictions, decreases in case incidence rate ratios
for unvaccinated versus fully vaccinated persons with and without booster vaccine doses
were observed when the Omicron variant emerged in December 2021. Protection against
infection and death during the Delta-predominant period against infection during Omicron
emergence were higher among booster vaccine dose recipients, and especially among
persons aged 50–64 and ≥65 years.
What are the implications for public health practice? COVID-19 vaccination protected
against SARS-CoV-2 infection, even as the Omicron variant became predominant. All eligible
persons should stay up to date with COVID-19 vaccination."
Science: Neutralization of SARS-CoV-2 Omicron by BNT162b2 mRNA vaccine–elicited human
sera (18 January 2022)
"The globally-circulating SARS-CoV-2 Variant of Concern Omicron (B.1.1.529) has a large
number of mutations especially in the spike protein, indicating that recognition by
neutralizing antibodies may be compromised. We tested Wuhan, Beta, Delta, or Omicron
pseudoviruses with sera of 51 participants that received two or three doses of the mRNA-
based COVID-19 vaccine BNT162b2. Following two doses, sera had >22-fold reduced
neutralizing titers against Omicron compared to Wuhan pseudovirus. One month after the
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
third vaccine dose, Omicron-neutralizing titers were increased 23-fold compared to two
doses, with titers similar to Wuhan-neutralizing titers after two doses. The requirement of a
third vaccine dose to effectively neutralize Omicron was confirmed using live SARS-CoV-2 in
a subset of participants. These data suggest that three doses of the mRNA vaccine
BNT162b2 may protect against Omicron-mediated COVID-19."
COVID-19 Vaccines
News in Brief
"Florida health official placed on leave after encouraging employees to get vaccinated" (WP).
"Why more Americans are saying they're 'vaxxed and done' — COVID has always divided
Americans. The Omicron wave is even dividing the vaccinated" (Atlantic).
Journal Articles
MMWR: Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19–Associated
Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During
Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August
2021–January 2022 (early release 21 January 2021)
"What is already known about this topic? COVID-19 mRNA vaccine effectiveness (VE) in
preventing COVID-19 might decline because of waning of vaccine-induced immunity or
variant immune evasion.
What is added by this report? VE was significantly higher among patients who received their
second mRNA COVID-19 vaccine dose <180 days before medical encounters compared with
those vaccinated ≥180 days earlier. During both Delta- and Omicron-predominant periods,
receipt of a third vaccine dose was highly effective at preventing COVID-19–associated
emergency department and urgent care encounters (94% and 82%, respectively) and
preventing COVID-19–associated hospitalizations (94% and 90%, respectively).
What are the implications for public health practice? All unvaccinated persons should start
vaccination as soon as possible. All adults who have received mRNA vaccines during their
primary COVID-19 vaccination series should receive a third dose when eligible, and eligible
persons should stay up to date with COVID-19 vaccinations."
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
MMWR: Use of the Janssen (Johnson & Johnson) COVID-19 Vaccine: Updated Interim
Recommendations from the Advisory Committee on Immunization Practices — United States,
December 2021 (21 January 2022)
"What is already known about this topic? Cases of thrombosis with thrombocytopenia
syndrome and Guillain-Barré syndrome have been reported after receipt of Janssen COVID-
19 vaccine.
What is added by this report? On December 16, 2021, after reviewing updated vaccine
effectiveness and safety data, the Advisory Committee on Immunization Practices made a
preferential recommendation for the use of mRNA COVID-19 vaccines over the Janssen
adenoviral-vectored COVID-19 vaccine in all persons aged ≥18 years in the United States.
What are the implications for public health practice? Pfizer-BioNTech or Moderna mRNA
COVID-19 vaccines are preferred over the Janssen COVID-19 vaccine for primary and
booster vaccination. The Janssen COVID-19 vaccine may be considered in some situations,
including for persons with a contraindication to receipt of mRNA COVID-19 vaccines."
JAMA Netw Open: Frequency of Adverse Events in the Placebo Arms of COVID-19 Vaccine
Trials: A Systematic Review and Meta-analysis (18 January 2022)
"Question What was the frequency of adverse events (AEs) in the placebo groups of COVID-
19 vaccine trials?
Findings In this systematic review and meta-analysis of 12 articles including AE reports for
45 380 trial participants, systemic AEs were experienced by 35% of placebo recipients after
the first dose and 32% after the second. Significantly more AEs were reported in the vaccine
groups, but AEs in placebo arms (“nocebo responses”) accounted for 76% of systemic AEs
after the first COVID-19 vaccine dose and 52% after the second dose.
Meaning This study found that the rate of nocebo responses in placebo arms of COVID-19
vaccine trials was substantial; this finding should be considered in public vaccination
programs.
Importance Adverse events (AEs) after placebo treatment are common in randomized
clinical drug trials. Systematic evidence regarding these nocebo responses in vaccine trials is
important for COVID-19 vaccination worldwide especially because concern about AEs is
reported to be a reason for vaccination hesitancy.
Conclusions and Relevance In this systematic review and meta-analysis, significantly more
AEs were reported in vaccine groups compared with placebo groups, but the rates of
reported AEs in the placebo arms were still substantial. Public vaccination programs should
consider these high rates of AEs in placebo arms."
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Breakthrough Infections and Reinfections
News in Brief
"Omicron is forcing us to rethink mild COVID – The staggering number of infections among the
vaccinated is changing Americans’ pandemic mindset" (Atlantic).
Journal Articles
JAMA: Comparison of mRNA-1273 and BNT162b2 Vaccines on Breakthrough SARS-CoV-2
Infections, Hospitalizations, and Death During the Delta-Predominant Period (20 January 2022)
"This study examines breakthrough SARS-CoV-2 infections, hospitalizations, and mortality in
March-August 2021, when the Delta variant predominated, among a general US cohort
vaccinated with mRNA-1273 or BNT162b2."
MMWR: COVID-19 Cases and Hospitalizations by COVID-19 Vaccination Status and Previous
COVID-19 Diagnosis — California and New York, May–November 2021 (early release 19 January
2022)
"What is already known about this topic? Data are limited regarding the risks for SARS-CoV-
2 infection and hospitalization after COVID-19 vaccination and previous infection.
What is added by this report? During May–November 2021, case and hospitalization rates
were highest among persons who were unvaccinated without a previous diagnosis. Before
Delta became the predominant variant in June, case rates were higher among persons who
survived a previous infection than persons who were vaccinated alone. By early October,
persons who survived a previous infection had lower case rates than persons who were
vaccinated alone.
What are the implications for public health practice? Although the epidemiology of COVID-
19 might change as new variants emerge, vaccination remains the safest strategy for
averting future SARS-CoV-2 infections, hospitalizations, long-term sequelae, and death.
Primary vaccination, additional doses, and booster doses are recommended for all eligible
persons. Additional future recommendations for vaccine doses might be warranted as the
virus and immunity levels change."
Clin Infect Dis: Necessity of COVID-19 Vaccination in Persons Who Have Already Had COVID-19
(13 January 2022)
"Background: The purpose of this study was to evaluate the necessity of COVID-19
vaccination in persons with prior COVID-19.
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
Methods: Employees of Cleveland Clinic working in Ohio on Dec 16, 2020, the day COVID-19
vaccination was started, were included. Anyone who tested positive for COVID-19 at least
once before the study start date was considered previously infected. One was considered
vaccinated 14 days after receiving the second dose of a COVID-19 mRNA vaccine. The
cumulative incidence of COVID-19, symptomatic COVID-19, and hospitalizations for COVID-
19, were examined over the next year.
Results: Among 52238 employees, 4718 (9%) were previously infected, and 36922 (71%)
were vaccinated by the study's end. Cumulative incidence of COVID-19 was substantially
higher throughout for those previously uninfected who remained unvaccinated than for all
other groups, lower for the vaccinated than unvaccinated, and lower for those previously
infected than those not. Incidence of COVID-19 increased dramatically in all groups after the
Omicron variant emerged. In multivariable Cox proportional hazards regression, both prior
COVID-19 and vaccination were independently associated with significantly lower risk of
COVID-19. Among previously infected subjects, a lower risk of COVID-19 overall was not
demonstrated, but vaccination was associated with a significantly lower risk of symptomatic
COVID-19 in both the pre-Omicron (HR 0.60, 95% CI 0.40-0.90) and Omicron (HR 0.36, 95%
CI 0.23-0.57) phases.
Conclusions: Both previous infection and vaccination provide substantial protection against
COVID-19. Vaccination of previously infected individuals does not provide additional
protection against COVID-19 for several months, but after that provides significant
protection at least against symptomatic COVID-19."
NEJM: Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines (12 January
2022)
"Background: Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since
December 2020 in the United Kingdom. Real-world data have shown the vaccines to be
highly effective against Covid-19 and related severe disease and death. Vaccine
effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S
(ChAdOx1 nCoV-19) and BNT162b2 vaccines.
Methods: We used a test-negative case-control design to estimate vaccine effectiveness
against symptomatic Covid-19 and related hospitalization and death in England.
Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to
participant age and status with regard to coexisting conditions and over time since receipt
of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7
(alpha) and B.1.617.2 (delta) variants.
Results: Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked
in the early weeks after receipt of the second dose and then decreased by 20 weeks to
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3%
(95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was
greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks
or more after vaccination, vaccine effectiveness decreased less against both hospitalization,
to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0)
with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI,
88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization
was observed in persons 65 years of age or older in a clinically extremely vulnerable group
and in persons 40 to 64 years of age with underlying medical conditions than in healthy
adults.
Conclusions: We observed limited waning in vaccine effectiveness against Covid-19-related
hospitalization and death at 20 weeks or more after vaccination with two doses of the
ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a
clinical risk group."
NEJM: Effectiveness of Covid-19 Vaccines over a 9-Month Period in North Carolina (12 January
2022)
"Background: The duration of protection afforded by coronavirus disease 2019 (Covid-19)
vaccines in the United States is unclear. Whether the increase in postvaccination infections
during the summer of 2021 was caused by declining immunity over time, the emergence of
the B.1.617.2 (delta) variant, or both is unknown.
Methods: We extracted data regarding Covid-19-related vaccination and outcomes during a
9-month period (December 11, 2020, to September 8, 2021) for approximately 10.6 million
North Carolina residents by linking data from the North Carolina Covid-19 Surveillance
System and the Covid-19 Vaccine Management System. We used a Cox regression model to
estimate the effectiveness of the BNT162b2 (Pfizer-BioNTech), mRNA-1273 (Moderna), and
Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines in reducing the current risks of Covid-
19, hospitalization, and death, as a function of time elapsed since vaccination.
Results: For the two-dose regimens of messenger RNA (mRNA) vaccines BNT162b2 (30 μg
per dose) and mRNA-1273 (100 μg per dose), vaccine effectiveness against Covid-19 was
94.5% (95% confidence interval [CI], 94.1 to 94.9) and 95.9% (95% CI, 95.5 to 96.2),
respectively, at 2 months after the first dose and decreased to 66.6% (95% CI, 65.2 to 67.8)
and 80.3% (95% CI, 79.3 to 81.2), respectively, at 7 months. Among early recipients of
BNT162b2 and mRNA-1273, effectiveness decreased by approximately 15 and 10
percentage points, respectively, from mid-June to mid-July, when the delta variant became
dominant. For the one-dose regimen of Ad26.COV2.S (5 × 1010 viral particles), effectiveness
against Covid-19 was 74.8% (95% CI, 72.5 to 76.9) at 1 month and decreased to 59.4% (95%
CI, 57.2 to 61.5) at 5 months. All three vaccines maintained better effectiveness in
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NMCP COVID-19 Literature Report #85: Friday, 21 January 2022
Tracy C. Shields, MSIS, AHIP (Reference Medical Librarian at Naval Medical Center Portsmouth, Library Services)
preventing hospitalization and death than in preventing infection over time, although the
two mRNA vaccines provided higher levels of protection than Ad26.COV2.S.
Conclusions: All three Covid-19 vaccines had durable effectiveness in reducing the risks of
hospitalization and death. Waning protection against infection over time was due to both
declining immunity and the emergence of the delta variant."
Treatments and Management
News in Brief
Due to the Omicron variant, updated NIH COVID guidelines recommend against two
monoclonal antibody cocktails (bamlanivimab/etesevimab and casirivimab/imdevimab) for
early treatment, and instead recommend sotrovimab or a 3-day course of remdesivir for such
outpatients (NIH).
"FDA takes actions to expand use of treatment for outpatients with mild-to-moderate COVID-
19" (FDA).
"Dozens of firms to make cheap version of Merck COVID pill for poorer nations" (Reuters).
Journal Articles
CMAJ: Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a
randomized controlled trial (19 January 2022)
"Background: The role of remdesivir in the treatment of patients in hospital with COVID-19
remains ill defined in a global context. The World Health Organization Solidarity randomized
controlled trial (RCT) evaluated remdesivir in patients across many countries, with Canada
enrolling patients using an expanded data collection format in the Canadian Treatments for
COVID-19 (CATCO) trial. We report on the Canadian findings, with additional demographics,
characteristics and clinical outcomes, to explore the potential for differential effects across
different health care systems.
Methods: We performed an open-label, pragmatic RCT in Canadian hospitals, in conjunction
with the Solidarity trial. We randomized patients to 10 days of remdesivir (200 mg
intravenously [IV] on day 0, followed by 100 mg IV daily), plus standard care, or standard
care alone. The primary outcome was in-hospital mortality. Secondary outcomes included
changes in clinical severity, oxygen- and ventilator-free days (at 28 d), incidence of new
oxygen or mechanical ventilation use, duration of hospital stay, and adverse event rates.
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